Transmandibular, circumglossal, retropharyngeal approach for chordomas of the clivus and upper cervical spine

Abstract

<jats:p>Extensive clival tumors that involve both the midline and lateral skull base compartments, or those that extend inferiorly to the anterior cervical spine, are difficult to expose in a wide fashion using any of the transmaxillary, transoral, or transcervical routes. In the transmandibular, circumglossal, retropharyngeal (TCR) approach wide access of this region can be obtained, thus allowing for a more complete resection of tumor and infiltrated bone. It also provides for an improved ability to perform dural reconstruction, should it be necessary. Over the past 4 years four patients with extensive clival chordomas underwent resection via the TCR approach. Gross-total resection was achieved in two patients, a greater than 98% resection in one patient, and a greater than 95% resection in the fourth patient. The surgical technique, all approach-related complications and morbidity, and patient outcome are discussed. If an expanded exposure of the clivus is necessary, the TCR approach is a good choice as well as a useful surgical technique to have available.</jats:p>

Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach

“…None of these approaches will be described as they have already been the subject of numerous other publications. 2,3,11,18,27,30,34,35,41,49,[53][54][55][56][57]61,63 Among these 43 patients, 19 (44%) were female, and the median age of the entire group was 43.7 years. The median duration of symptoms was 6.8 months.…”

“…(LeFort I maxillotomy), 18,35,49 and anterior cervical decompression and fusion. 6,60 The lateral approaches comprise the pterional, frontoorbitozygomatic, 61 infratemporal, 54,57 transpetrosal, 3,30,44,53 combined suprainfratentorial retrosigmoid, 25,63 and far lateral suboccipital.…”

Transmaxillary and Transmandibular Approach to a C1 Chordoma

“…However, the anterior craniocervical junction is a difficult region to expose well using any of the transmaxillary, transoral, or transcervical approaches. 3 In this report, we have described the efficacy of a transmaxillary and transmandibular approach in achieving wide exposure of a chordoma of the upper cervical spine, although an en bloc resection was impossible. This approach was a combination of already established approaches: Le Fort I osteotomy, midfacial degloving, and median labiomandibular glossotomy.…”

Surgical results of an endoscopic endonasal approach for clival chordomas

“…The anterior approaches are more often used because chordomas are typically midline in location and are extradural tumors. Anterior approaches include the transbasal approach, transsphenoidal approach, lateral rhinotomy, transoral/transpalatal approach, and transfacial approach [8,9,16,25,30,31,35,36,38,39]. Most of these approaches are performed under the microscope, and the view of microscopic approaches is the limited.…”